Current Problems in Diagnostic Radiology 46 (2017) 382–384
Current Problems in Diagnostic Radiology
journal homepage: www.cpdrjournal.com
Change Management—A Radiology Administrator's Primer
Prabhakar Rajiah, MDa, Puneet Bhargava, MDb,n
a
Department of Radiology, UT Southwestern Medical Center, Dallas, TX
b
Department of Radiology, School of Medicine, University of Washington, Seattle, WA
Radiology is no exception to the ubiquitous presence of change in every aspect of our life. Managing change is a challenge, with a high probability of
failure if not properly implemented. While change management is not part of the radiology curriculum, it is a highly specialized discipline in the business
world. It has been extensively researched and has emerged as a vital skillset in the management of major projects. In this article, the authors discuss how
these change management strategies of the business world can be put to use in the radiologists’s practice.
Change Management—A Radiology Administrator's Primer
“Change is the Only Constant in Life”—Heraclitus
Radiology is no exception to the ubiquitous presence of change
in every aspect of our life. Change can vary in extent from minor to
disruptive. Changes in radiology be seen either in technology,
policy, process or strategy. Some changes are initiated voluntarily
but other changes are forced because of larger governmental or
policy changes on a national or international level. Disruptive
change involve a new product, technology, or service that does not
address the existing needs of the main market or audience, but has
unique advantages which establishes a new market for itself and is
gradually accepted by the mainstream. Some examples of changes
that are encountered in radiology include changes in health care
systems, insurance, reimbursements; acquisitions, and mergers of
new hospitals; new leadership and culture; changes in imaging
hardware and software; practice-changes based on new evidence
and guidelines; establishing a new service; new clinical workflow;
new protocols; new curriculum and boards; new conferences;
changing academic and clinical productivity; and incentive
requirements. These changes can have a profound effect not only
on the staff but also on the well-being of the patients.
Change is challenging and usually evokes resistance. There is a
high chance of failure if change is not properly implemented.
While change management is not part of the radiology curriculum,
it is a highly specialized discipline in the business world. It has
been extensively researched and has emerged as a vital skillset in
the management of major projects. Change management is a
structured approach that is adopted by business organizations to
ensure that changes are smoothly and successfully implemented
achieving the lasting benefits of change. There are several well-
established models of change management in the business world,
Disclosure for Puneet Bhargava: Editor-in-chief, Current Problems in Diagnostic
Radiology, Elsevier Inc.
n
Reprint requests: Puneet Bhargava, MD, Department of Radiology, School of
Medicine, University of Washington Medical Center, 1959 NE Pacific St, Room
BB308, Box 357115, Seattle, WA 98195-7115.
E-mail address: bhargp@uw.edu (P. Bhargava).
http://dx.doi.org/10.1067/j.cpradiol.2017.06.010
0363-0188/& 2017 Elsevier Inc. All rights reserved.
& 2017 Elsevier Inc. All rights reserved.
which can be effectively used in radiology. One model which is
well-suited to health care and radiology is Prosci's Awareness,
Desire, Knowledge, Ability and Reinforcement model (ADKAR
model), a goal oriented model that allows teams to focus on
specific results.1 A sustaining change is an evolutionary change
that makes a product or service perform better in a way that is
valued by the market or audience.2 Discussed in this article are few
strategies that radiologists will find useful in understanding and
managing change.
Strategies for Change Management
The following strategies from the business world can be
adopted in the radiology department.
(1) Understand the change
The first and foremost step in change management is to
thoroughly understand the nature of the change itself and the
need for it. Although we prefer change to be a choice and
optional, often it is a necessity and inevitable. For example,
national laws such as the affordable health care act, national
level policy changes such as reimbursement or incentive
payments or national level curriculum and board examina-
tion changes are issues over which an individual or radiology
department has minimal control. However, these necessitate
major changes in the radiology department as well to be
compliant with the new requirements or regulations. Acquir-
ing new hospitals, along with their radiology departments is
not a forced change, but has become an important need to
expand the business in the changing health care and reim-
bursement environment. On the other hand, adoption of a
new radiation dose reduction technique is often optional.
Studies on consumer technology products have shown that
any new technology is adopted over time in a bell curve
pattern, with only a small number (2.5%) of innovators using
the technology first, followed by early adopters (13.5%), early
majority (34%), late majority (34%), and finally laggards
(16%).3 Being an innovator has its reward of being a trend
 P. Rajiah, P. Bhargava / Current Problems in Diagnostic Radiology 46 (2017) 382–384
setter, particularly in research and new applications. Having
the latest technology is also a great marketing tool to attract
not only new patients but also a valuable recruitment tool for
attracting new talent as well as retain existing talent. The
absence of priori knowledge of the technology and financial
back-up required in the event of failure.
(2) Assess the capabilities
An organization should initially review its ability to handle any
proposed change. This review should assess available resources,
processes, and institutional values. Resources include human,
technical, designs, and customer relationships. Processes can be
either formal or informal and include communication and
interaction patterns, training, marketing analysis, budgeting,
and decision-making protocols. For example, if a radiation dose
reduction program is established, there should be a process to
record the radiation doses; appropriate communication and
alerts when the doses are higher; and regular meetings of a
committee to review and refine dose reduction strategies.
Values are inherent to a specific organization and determine
the priorities of the organization, that is, clinical, financial,
academic, or a combination of these. The decision to commit
on a new venture and acceptable margins and size of business
are also value decisions. For example, if the department opts to
be more academic, this should be a value that is inherent and
acceptable in not only the department but the entire hospital so
that there is widespread support and encouragement.4
(3) Select the appropriate structure and team
Effective change management takes into account all the
factors and people involved, best illustrated by Prosci's
methodology. First, an appropriate strategy is selected. This
should be simple, practical, logical, structured, comprehen-
sive, easy to understand, implement, and communicate. It is
also absolutely vital to select an appropriate team. Change
management should be implemented early to ensure that it is
proactive and smooth.1,5 The selection of appropriate struc-
ture and team largely depends on how they fit in with the
existing resources, values, and processes.
Steering committees, which involve key stakeholders (both
internal and external including change management consul-
tants) should be created. The leadership and members of this
team should be determined based on the task involved. For
example, if the hospital decides to pursue a lung cancer
screening program, the steering committee should include
radiologists, technologists, pulmonologists, oncologists, sur-
geons, nurse navigators, and hospital executives. They can also
create smaller working groups within each specialty or division
to offer more specific guidance and implementation strategies.
(4) Prepare for change
When the structure and the team is in the place, the next step
is to prepare for the change. The need for change, the vision
for change and the entire change management process
should be clearly communicated to everybody involved,
regardless of their place in the hierarchial structure. The
vision should both include the overarching big picture organ-
izational vision, as well as the specifics of the change
including the process and management team. A sense of
urgency should be established in the implementation of
change management program. For example, if there is a
departmental plan for cost cutting due to low revenues and
there is a redesigning of the compensation plan, the data on
the need for change should be clearly laid out to the faculty
and staff members in meetings. The terms of negotiations
with the higher authorities in the hospital should be trans-
parently discussed to ensure that there is clear understanding
and a perception of a fair process. The plan for the next year
or two should also be laid out which will help the team
383
members in planning for the future. On top of these general
meetings, management can also delegate staff members to
speak specifically to individual members so that everything is
communicated.
(5) Implement the change
The next step is to implement the change itself as per the
planned process. The leadership and management responsi-
ble for the change should ensure that everything is imple-
mented the way it was planned. At an individual level, the
ADKAR model can be applicable, where the individual should
have the Awareness, Desire, Knowledge, Ability, and Rein-
forcement for the proposed change.1 This helps in planning
change management activities, diagnosing gaps, developing
corrective actions, and supporting supervisors.
(6) Manage the individuals during transition
The success of change management ultimately depends on the
individual. Hence, it helps to understand how an individual
would respond to change, particularly a change that they are
not comfortable with. This response has been considered
analogous to bereavement, explained by Kubler Ross in 5
stages, including denial, anger, depression, bargaining, and
finally acceptance.6 During denial phase, there is avoidance,
confusion, shock, and fear. During anger, there is frustration,
and anxiety. With depression, the individual is overwhelmed,
helpless, or hostile. During bargaining, he struggles to find
meaning, reaches out to others, and tells his story. Finally, with
acceptance, they explore options, develop new plans, and
move on. Understanding these stages helps in managing the
individual as they go through these changes. However, not all
change is bad and the response does not always goes through
these stages. The Bridges transition model says that change is
situational and often occurs without transition, which is a
psychological process that has 3 phases where people gradu-
ally accept change.7 The first phase is “endings”, in which
people let go of what used to be the norm. There is acknowl-
edgement of the loss and identification of who is losing what.
The second phase is the “neutral zone”, in which people begin
to explore the change. There is ambiguity, disorientation, poor
motivation and anxiety. The final phase is the “new begin-
nings” with acceptance of change and its purpose. Tools such
as dashboard help in understanding the required changes and
acts as benchmark for ensuring that targets are met.
(7) Expect resistance and remove obstacles to change
Any change faces resistance and is not immediately accepted
by all the parties concerned. Leadership should be aware of
this and should be proactive in identifying resistance. If
change is compromised by disruptive individuals, they have
to be addressed immediately. Even well planned and exe-
cuted programs can be derailed due to unexpected obstacles,
some of which may be out of our hands. For example, if an
incentive system has been established to boost academic or
clinical productivity, it may be derailed if the revenues do not
keep up to the expectations.
(8) Obtain regular feedback
Once the change is implemented, it should be monitored with
a feedback process to ensure that the change is effective. The
steering committee should meet regularly to evaluate the
feedback, assess if the process is successful, identify chal-
lenges, and design alternative pathways. For example, the
recently introduced core board examination format for radi-
ologists warranted a major redesigning of the radiology
curriculum and training. For this, new educational and mile-
stone committees were created, who worked on changing the
individual rotations as well as the milestones to ensure that
the residents are successful in the core examinations. In
addition, the lectures were revamped to make them useful
384 P. Rajiah, P. Bhargava / Current Problems in Diagnostic Radiology 46 (2017) 382–384
for residents to pass the core examinations. A key component
of this is to get feedback from the residents themselves if the
new lectures are fulfilling their objectives. The scorings were
reviewed by the education committee and if the objectives
were not met, they were communicated to the faculty so that
they can modify the lectures to the new format. Processes
such as these ensure that the change is sustainable.
(9) Reinforce change
Changes are long-lasting when they get reinforced and become
embedded in the culture of the organization. A major step is to
help each individual understand how the overall performance
has improved after the change and how they have contributed
towards that. This will help the individuals. For example, if the
department wants to develop a culture of innovation, after
making the initial system changes as described earlier, it
should be reinforced everybody that innovation has become
an inherent part of the department culture, visibly rewarded,
and hence everybody strives for it.
(10) Celebrate success
Celebrating success encourages those who went through the
change process and is an important component of change
management. Occasionally, change may take years to achieve,
and in such a situation it is important to create short-term goals
and wins. Leadership should establish clear short-term per-
formance improvement goals within the framework of change
and celebrate success by rewards, events promotion, or bonuses.
This will reinforce to the employees that progress is being made
toward the larger goal and make sure that the levels or urgency
and momentum do not fall off. Without such short-term
celebrations, the employees may get discouraged or may join
the ranks of people who are resisting the change. However, a
premature declaration of victory should be avoided since it may
lead to incomplete change management, loss of motivation and
even complete failure of the project. It should be made clear
that the celebration is only for a short-term victory.8
(11) Beware of causes of failure
Change management is successful if implemented in a sys-
tematic fashion with a clear vision and adequate time. In
addition, an awareness of the common causes of failure in
change management will help in minimizing the chances of
failure. For example, Kotter has identified 8 common causes
of failure of change management. These include-not estab-
lishing sense of urgency; not forming a powerful guiding
coalition; lacking a vision; under-communicating the vision;
not removing obstacles to the new vision; not systemically
planning for and creating short-term wins; declaring victory
too soon; and not anchoring changes to the culture of the
corporation. Radiology leadership should be cognizant of
these mistakes and avoid them at all costs.9
Conclusion
Change management is a well-established and structured
discipline in the business world, which offers many toolsets that
can be easily translated to the radiology world to effectively
manage change.
Take Home Points
(1) Managing change is a challenge, with a high probability of
failure if not properly implemented. While change manage-
ment is not part of the radiology curriculum, it is a highly
specialized discipline in the business world. It has been
extensively researched and has emerged as a vital skillset in
the management of major projects.
(2) Change management is a structured approach that is adopted
by business organizations to ensure that changes are smoothly
and successfully implemented achieving the lasting benefits of
change. There are several well-established models of change
management, which can be effectively translated to be used in
radiology.
(3) Although change is intimidating it is also often necessary.
Discussed in our article are few strategies that radiologists will
find useful in understanding and managing change.
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